Healthcare Provider Details

I. General information

NPI: 1093907099
Provider Name (Legal Business Name): NICOLE BOUNDS RIIS AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 DAUPHIN ST
MOBILE AL
36606-2457
US

IV. Provider business mailing address

2880 DAUPHIN ST
MOBILE AL
36606-2457
US

V. Phone/Fax

Practice location:
  • Phone: 251-473-1900
  • Fax: 251-470-8943
Mailing address:
  • Phone: 251-473-1900
  • Fax: 251-470-8943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1095A
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD004012
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1095A
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number764
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: